Editor’s Note: We’re thrilled to welcome Claire Gill, CEO of the BHOF—Bone Health & Osteoporosis Foundation. BHOF is the leading health organization dedicated to preventing osteoporosis and broken bones. Anne Akers our health, beauty and wellness editor, interviewed Claire for this first post in our new monthly column on Bone Health with Claire Gill.

What is osteoporosis, and why is it referred to as a “silent” disease?

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break.

Osteoporosis is often called a silent disease because one can’t feel bones weakening. Breaking a bone is often the first sign of osteoporosis, or a patient may notice that he or she is getting shorter or their upper back is curving forward. If you are experiencing height loss or your spine is curving, be sure to consult your doctor or healthcare professional immediately.

Which factors put one at risk for osteoporosis?

There are uncontrollable and controllable risk factors for osteoporosis: We can’t change the basic biological facts of our lives–things like sex, age, and genetic heritage. Some of these factors are strongly linked with weak bones and osteoporosis.

Uncontrollable risk factors include:

• Older Age. People can get osteoporosis at any age, but it is rare under age 50.
• Female Gender. Women are twice as likely to get osteoporosis as men. About half of women and one quarter of men over age 50 will break a bone in their remaining lifetime. For women, this is equal to the risk of getting cancers of the breast, ovaries, and uterus combined. For men, the risk is about the same as for getting prostate cancer
• Menopause. In women, the sex hormone estrogen protects bones through adolescence and young adulthood. When estrogen drops off sharply at menopause, bone mineral loss speeds up, and bones become brittle and more prone to breaking.
• Family History. Like many things, osteoporosis runs in families. If either of your parents broke a bone as an adult, your risk is higher.
• Body Type. Small and thin people tend to break more bones.
• Broken Bones/Height Loss. People who break a bone as an adult may already have osteoporosis and not know it. Some broken bones are obvious and some are hard to detect. Vertebral fractures in your spine can be painless. These fractures may not be discovered until a person has developed extreme curvature of the spine or height loss.
• Many medications can be associated with bone loss, such as steroid use. It is important to check with your physician if you are on medications that can attribute to loss of bone health.

Controllable Risk Factors include:

• Calcium and vitamin D deficiency
• Smoking
• Lack of exercise
• Excessive alcohol intake

Who should get screened? What are the current guidelines?

Current guidelines recommend that women over 65 and men over 70 get screened for osteoporosis. In addition, anyone who has broken a bone at 50 or older, or who has risk factors as outlined above, needs to be screened. The best screening is a bone density test which is accomplished through dual-energy X-ray absorptiometry, a DXA scan. You can receive an order for a DXA scan from your physician.

What is the difference between osteoporosis and osteopenia?

Osteopenia is a condition that often leads to osteoporosis, and it occurs when the body does not make bone as quickly as it reabsorbs old bone. Hormonal imbalances or autoimmune conditions can often contribute to osteopenia. Osteopenia is an indicator of low bone density, which is a precursor to osteoporosis. If you are diagnosed with osteopenia, it is important to work with your physician to make lifestyle changes in diet and exercise that could mitigate your risk of developing osteoporosis.

Which medical professional should I consult with if diagnosed?

Treatment for osteoporosis is often multi-disciplinary. It is best to start with your primary care physician, who may refer you to an endocrinologist or a rheumatologist. Orthopedics, gynecologists, and geriatricians can all diagnose and treat osteoporosis too. To find a healthcare professional who practices care and treatment for osteoporosis, you can start by referring to the Find a Professional directory on our website: https://www.bonehealthandosteoporosis.org/find-a-professional/

What is the most commonly prescribed medication for osteoporosis?

There are many safe and effective medications available to treat osteoporosis and reduce the risk of fracture. They fall into two basic categories: antiresorptives and anabolics.

• Antiresorptive drugs include bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), denosumab, calcitonin, estrogen/estrogen-progestin, an estrogen agonist/antagonist (raloxifene), and a tissue specific estrogen complex (estrogen/bazedoxifene). Antiresorptive drugs work by slowing the resorption or breakdown part of the remodeling cycle.
• Anabolics work by stimulating the formation part of the remodeling process. More bone is formed than is taken away. The result is stronger bone that is less likely to break. Teriparatide, a parathyroid hormone analog, abaloparatide, a parathyroid hormone-related protein analog, and romosozumab-aqqg, a sclerostin inhibitor, are the FDA-approved anabolic medicines available at this time. It is important to consult your healthcare professional to see if medication is right for you.

How much calcium and vitamin D is recommended to prevent bone loss?

• Every day, we lose calcium through our skin, nails, hair, sweat, urine and feces. The body cannot produce its own calcium, and it cannot use calcium efficiently without vitamin D. That’s why it’s important to get enough calcium and vitamin D from the food we eat. The amount of calcium and vitamin D you need every day depends on your age and sex.
• Women age 50 and younger need 1,000 mg of calcium per day. Women age 51 and older need 1,200 mg of calcium per day. Men 70 and younger need 1,000 mg of calcium per day and men 71 and older need 1,200 mg of calcium per day.
• Women and men 50 and younger need 400-800 international units (IU) of vitamin D per day and women and men 51 and older need 800-1,000 IU per day.

Which exercises are recommended to build bone?

• Weight-bearing and muscle-strengthening exercises are best for building and maintaining strong bones. The bone responds to the pressure of weight lifting and resistance training. Before starting any exercise program it’s important to consult with a medical professional. If you are cleared by your healthcare professional to exercise, you visit the BHOF website to see if there is a Bonefit™ certified fitness professional near you: https://www.bonehealthandosteoporosis.org/bonefit-find-a-professional/.

How does one practice fall prevention?

Many factors can lead to a fall: poor balance, weak muscles, foot pain, vision problems, certain diseases, alcohol use, certain medications, and hazards in the home. It is important to safety proof your home, and if needed, install grab bars in bathrooms or other places where stability is a factor. Install rug pads under rugs on smooth surfaces, and ensure that stairs have proper railings.